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By Ginger - Site Admin on Thursday, February 16, 2017 1:11 PM
On February 15, the Centers for Medicare and Medicaid Services (CMS) released a proposed rule designed to stabilize the health insurance marketplace for 2018. The proposed rule would verify eligibility of individuals who newly enroll through special enrollment periods, which has been a concern of insurers with respect to individuals waiting until they need coverage to enroll. It will also allow an insurer to collect premiums for prior unpaid coverage before enrolling an individual in next year’s plan with the same insurer. This is designed to encourage patients to avoid coverage lapses. The rule would also move the assessment of network adequacy to states, and it would shorten the open enrollment for the 2018 coverage year to run from November 1, 2017, through December 15, 2017.

The proposed rule can be found at https://www.federalregister.gov/documents/2017/02/17/2017-03027/patient-protection-and-affordable-care-act-market-stabilization...
By Ginger - Site Admin on Monday, September 28, 2015 8:48 AM
On September 25, the Centers for Medicare & Medicaid Services (CMS) issued a proposed rule that would revise the Medicare payment system for clinical diagnostic laboratory tests and implement other changes required by section 216 of the Protecting Access to Medicare Act of 2014. Under the proposed rule, certain “applicable” laboratories would be required to report private payer rate and volume data if they receive at least $50,000 in Medicare revenues from laboratory services and more than 50% of their Medicare revenues from laboratory and physician services. Laboratories would collect private payer data from July 1, 2015 through Dec. 31, 2015 and report it to CMS by March 31, 2016. CMS would post the new Medicare rates by Nov. 1, 2016 for lab tests beginning Jan. 1, 2017. In a factsheet...
By Ginger - Site Admin on Wednesday, July 15, 2015 8:35 AM
The proposed calendar year (CY) 2016 payment rule for the Medicare Outpatient Prospective Payment System (OPPS) was published in the July 8 Federal Register. The proposed rule includes annual updates to the Medicare fee-for-service (FFS) outpatient payment rates as well as proposed regulations that implement new policies.

The Healthcare Association of New York State (HANYS) has shared a high-level summary of the proposed rule.

A copy of the Federal Register (FR) and other resources related to the OPPS are available on the Centers for Medicare and Medicaid Services (CMS) website. Comments on all aspects of the proposed rule are due to CMS by August 31 and can be submitted electronically at http://www.regulations.gov...
By Ginger - Site Admin on Wednesday, May 27, 2015 8:07 AM
On Tuesday, May 26, the Centers for Medicare and Medicaid Services (CMS) released a proposed rule that would update Medicaid and Children’s Health Insurance Program (CHIP) managed care regulations to better align them with existing commercial, Marketplace and Medicare Advantage regulations. The proposed rule, which is the first major update to Medicaid and CHIP managed care regulations in more than a decade, includes updates to managed care provider networks, quality measures, external quality review, and beneficiary rights and protections.

KHA staff is analyzing the rule for comments, which are due to CMS by July 27. KHA also submitted issues to CMS via AHA for their consideration in drafting the proposed rule to address problems experienced with managed care in Kentucky.

The regulation proposes a minimum medical loss ratio (MLR) of 85 percent beginning in 2017, standards around actuarial soundness of capitation rates, contracting standards and consumer protections. To read the entire rule, see...
By Ginger - Site Admin on Monday, July 14, 2014 10:23 AM
The Cabinet for Health and Family Services has filed proposed amendments to 902 KAR 20:008 – License procedures and fee schedule – to substantially increase the annual licensure fees for all health facilities, including hospitals. To view the changes, visit http://www.lrc.ky.gov/kar/902/020/008reg.htm. All types of hospitals will be charged at the same rate, regardless of whether the hospital has deemed status for licensure. Currently, the per-bed rate for deemed status hospitals is $5.00 lower. The current and proposed rates are as follows:
By Ginger - Site Admin on Monday, May 19, 2014 12:55 PM
On June 1, the Office of Health Policy will publish proposed changes to the following three Certificate of Need regulations: (1) Certificate of Need Non-substantive Review, (2) Certificate of Need Considerations for Formal Review, and (3) Certificate of Need Forms. ( A copy of each of these proposed amendments is available at the corresponding links.) These regulations were not filed as emergencies, and comments will be accepted through June 30. KHA’s Certificate of Need Committee will meet to discuss these changes and make recommendations for KHA’s comments....
By Ginger - Site Admin on Friday, March 28, 2014 2:38 PM
On March 27, KHA submitted comments to the Centers for Medicare and Medicaid Services (CMS) regarding the proposed Conditions of Participation (CoP) rule regarding emergency preparedness requirements for Medicare and Medicaid participating providers and suppliers.

A copy of KHA's comment letter is available at http://www.kyha.com/wp-content/uploads/2014/03/KHAResponsetoCMSCOPEPRules.pdf.

The AHA released a Regulatory Advisory on this topic. It is available at http://www.kyha.com/wp-content/uploads/2014/03/EmergencyPreparednessCOP_ProposedRule_RegulatoryAdv.pdf.

For further information, please contact Richard Bartlett at KHA (502-426-6220 or 800-945-4542 or via e-mail at rbartlett@kyha.com)....
By Ginger - Site Admin on Friday, January 17, 2014 12:22 PM
The Centers for Medicare & Medicaid Services (CMS) recently issued a proposed rule in the Federal Register that establishes national emergency preparedness requirements for Medicare and Medicaid providers and suppliers to ensure that they adequately plan for both natural and man-made disasters.

The proposed rule addresses emergency preparedness requirements that 17 provider and supplier types must meet in order to participate in the Medicare and Medicaid programs.

This proposed rule could have a significant impact on hospitals. For example, the rule includes language that relates to the behavior of the new electronic health record (EHR) systems during a disaster or emergency, and a requirement that EHR systems be redundantly backed up both in region and out of region.

KHA Emergency Preparedness Director Richard Bartlett has prepared resources for hospitals to educate themselves regarding the proposed changes and to prepare in case the rule is approved. Visit http://www.kyha.com/proposed-rule-change-on-cop-related-to-emergency-preparedness/...
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